Presenting author biography:

Dr. Mark Lysyshyn is a Medical Health Officer with Vancouver Coastal Health and an Assistant Clinical Professor with the School of Population and Public Health at the University of British Columbia.

Evaluation of a fentanyl drug checking program for clients of a supervised injection site, Vancouver, Canada

Mark Lysyshyn, Carolyn Dohoo, Sara Forsting, Thomas Kerr, Ryan McNeil

ISSUE: Vancouver is experiencing a public health emergency related to opioid overdoses driven in part by consumption of street drugs contaminated with illicitly manufactured fentanyl. We tested a novel harm reduction intervention in which clients of a supervised injection service were offered the opportunity to check their drugs for fentanyl.

SETTING: Insite is a facility offering supervised injection services in Vancouver’s Downtown East Side, a community with persistent high levels of individual and societal harms from injection drug use, including overdose deaths.

PROJECT: Clients of Insite were offered an opportunity to check a sample of their drugs for fentanyl using a test strip designed to test urine for fentanyl. Results of the drug check were recorded by Insite staff along with the substance checked, whether the client disposed of the drug or reduced the dose, experienced an overdose, or required treatment with naloxone. Qualitative interviews with individuals who did and did not access the drug checking service are being conducted.

OUTCOMES: From July to September, 2016, 472 fentanyl checks were performed on heroin (83% of cases), other opioids (2%), and other drugs not known to contain opioids (14%). Overall, 80% of drugs checked were positive for fentanyl (84% of heroin samples, 83% of other opioid samples, and 64% of non-opioid samples). Of substances checked pre-consumption, compared to receiving a negative result, receiving a positive result did result in more dose reductions (37% vs. 8%) but not in more disposals (9% vs. 8%). These findings must be interpreted in the Insite context where overdose treatment is readily available. An issue of interest is whether drug checking using these test strips could be safely offered in a community setting. It is reassuring that overdoses were less common with a negative drug check than with a positive check (2% vs. 9%).